Should I Try One of These Other Methods to Remove Wisdom Teeth?
I (Dr. Wagner) have been removing impacted wisdom teeth for over 30 years. I regularly have to treat very difficult cases, including cases where there is a significant risk to the neurovascular bundle in the jaw (inferior alveolar nerve), jaw cysts (odontogenic cysts), infections, and complicated/difficult extractions. I am an expert in this treatment and have treated thousands of patients, and I rarely have complications. Having said that, I have had complications including injury to the nerve in the jaw, but our complication rate is well below what is reported in the literature as average. We use proper imaging (I recommend cone beam imaging when there are advanced risks to the adjacent structures), we have and practice high surgical skills, and we are careful and gentle in our treatment technique (we genuinely care about our patients’ wellbeing and success with treatment).
I must interject here that the point of using other methods for removal of third molars only becomes an issue when there is inappropriate delay in removal of the teeth. Get them evaluated early (14-15 years old) and remove them early (typically about age 15), before root formation. All of these other risk concerns are generally avoided with that practice.
There are a number of techniques that have been put forward to aid in the treatment of difficult lower third molar (wisdom tooth) extractions. (J Oral Maxillofac Surg 79:1422.e1-1422.e8, 2021) These techniques include coronectomy (which I have blogged on before — and I am generally against) and orthodontic extrusion of third-molar teeth (which I feel is a reasonable treatment, but both expensive and uncomfortable). The cited article references the orthodontic eruption model. This technique historically was used to upright unusually angled impacted second- and third-molar teeth that we wished to save. In this present application, the idea is to use this technique to bring an impacted third-molar tooth into a more favorable position for its removal by first forcibly erupting it to a point where the roots are no longer in proximity to the sensory nerve in the lower jaw.
This technique requires a surgical procedure to attach a tether, such as an orthodontic wire or chain, to the impacted tooth. You must uncover and access the tooth surgically, bond (glue) or screw an attachment to the tooth and extend that attachment to the mouth, where orthodontic traction can be applied to the tooth to change its position. There are quite a few variables including surgical risks to the adjacent teeth and tissues, infection, and risks that the impacted molar will actually be caused to become ankylosed. In spite of these risks, I feel this technique is reasonable and effective for an individual who can afford the treatment time, general risks, and expense, and I do feel this treatment can reduce the risk of nerve injury.
Now having said all of that, I still feel that for me personally — I would trust my experienced, careful oral and maxillofacial surgeon, who has proper imaging and technique, to just remove the tooth surgically and comfortably under IV anesthesia.
on Mar 24th, 2022
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